ACOG’s New Labor Guidelines Fall in Step with ICAN’s Mission

ACOG’s New Labor Guidelines Fall in Step with ICAN’s Mission

New study shows that labor takes longer than previously believed, and it is safer in most cases for a woman to labor longer than for providers to push for cesarean birth.

The emphasis throughout the report is on patience during labor, which is critical for the success of a vaginal birth.

Providers should be better trained—and maintain their knowledge and education—in the practice of operative vaginal delivery methods (including forceps and vacuum delivery).

The presence of labor support personnel, such as a doula, significantly reduces the incidence of cesarean.

These new guidelines support what ICAN has been advocating for all along: safer, healthy, natural birth experiences for women, and a reduction of the incidence of cesarean birth.

February 27, 2014 – Newly released guidelines compiled by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) are encouraging the medical community to rethink its approach to cesarean delivery, with a goal of reducing the number of primary cesareans. This is exciting news for the birthing community as a whole, and ICAN especially, as it could open up a new world of birthing opportunities for women who traditionally would be pushed toward cesarean by their provider.

The guidelines, which can be found on ACOG’s website, call for a drastic change in the way the medical community has typically addressed labor and birth. The standard practices have, up until now, been based on research conducted in the 1950s, including Friedman’s curve for deciphering standard dilation and labor progression. However, the new studies conducted by the ACOG and SMFM have proven that labor happens at a much slower pace than previously thought. Friedman’s research had determined that the cervix should dilate at roughly 1.2-1.5 cm/hour. However, the new research has found that dilation typically happens at a rate somewhere between 0.5-1.3 cm/hour, depending on how many previous pregnancies a woman has had (among other factors). This is a significant difference in the presumed rates of dilation and will have an obvious and immediate impact on how labor is handled in the future, promoting longer first stage labor with less intervention.

The study also states that it is nearly impossible to determine a “standard” length of time for the second stage of labor, as there are so many varying factors that can impact the duration of this stage. While some negative maternal outcomes have been associated with a longer second stage, the numbers are minimal, even in cases where the second stage lasts five hours or longer. Again, labor as a whole should be allowed to progress naturally, with minimal intervention.

“There has been a disconnect between what medical research says and the way that hospitals and providers have practiced medicine for a long time” said Christa Billings, ICAN President. “These guidelines support what ICAN has been educating women on all along. While this report is encouraging, it fails to address the nationwide problem of hospital and provider vaginal birth after cesarean (VBAC) bans. With the primary cesarean rate at a high level, many women are seeking VBAC’s. This important issue needs to be addressed by ACOG.”

Besides slowing down and allowing the process of birth to happen naturally, the report also recommends that providers should have more training in operative vaginal birth methods such as forceps- and vacuum-assisted vaginal deliveries. The study purports that the practice of such assistive methods has fallen sharply as the use of cesareans has risen, and that by better educating providers in the use of these methods, cesareans can be avoided more frequently.

The cesarean rate has also been shown to be significantly less among women who have continuous labor support, such as a doula. The report points out that there is nothing negative about a doula—no physical side effects to either the mother or the baby—but rather a doula can make the whole birth experience more positive overall, and so this is one option that is tremendously underutilized.

This new report from ACOG is very propitious. It paves the way for new standards in the handling of labor and birth in medical settings. The guidelines come at a time when the cesarean rate in the United States is approximately 31.3%. Despite the rates not increasing over the past several years, the fact remains that this number is too high. ICAN hopes that the newly released guidelines will elicit a positive response from labor and birth professionals around the country who will act in accordance with this new standard of care.

Part of ICAN’s stance, as outlined in their Statement of Beliefs, is that “It is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective). Women are not being fully informed of the risks of this option in childbirth, and therefore make decisions based on cultural myth and fear surrounding childbirth.” These new guidelines, as set forth by the ACOG and Society for Maternal-Fetal Medicine (SMFM), are on track to help make sure that “non-medically indicated cesareans” happen less frequently and that women are given more opportunities to experience the natural process of labor and birth.

Of course, these changes will take time, and these standards will need much support—both socially and legally—if they are to be implemented at the individual hospital level. ICAN will continue to advocate on behalf of birthing women everywhere to help ensure that the standards are effectively put into place and met with compliance.

If you would like to find out more about ICAN, join a local chapter, or volunteer, please visit http://www.ican-online.org for more information.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are over 110 ICAN Chapters across North America and abroad, which hold educational and support meetings for people interested in cesarean prevention and recovery.

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About ICAN

The International Cesarean Awareness Network, Inc.
(ICAN) is a nonprofit organization whose mission is
to improve maternal-child health by preventing
unnecessary cesareans through education, providing
support for cesarean recovery, and promoting Vaginal
Birth After Cesarean (VBAC).